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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(08): 523-524
DOI: 10.1590/0004-282X20200019
Images in Neurology

Convulsive syncope: a Stokes-Adams case

Síncope convulsivo: un caso de Stokes-Adams
Laura CAIRE-HERRERA
1   Hospital Psiquiátrico Infantil Juan N. Navarro, Unidad Psiquiátrica, México.
,
Enrique GOMEZ-FIGUEROA 
2   Instituto Nacional de Neurología y Neurocirugía, Departamento de Neurología, México.
,
Roberto CERVANTES-URIBE 
2   Instituto Nacional de Neurología y Neurocirugía, Departamento de Neurología, México.
,
Ramiro ROSAS-GUTIERREZ
3   Instituto Nacional de Neurología y Neurocirugía, Departamento de Neurofisiología, México.
,
Álvaro MORENO-AVELLAN
3   Instituto Nacional de Neurología y Neurocirugía, Departamento de Neurofisiología, México.
,
Maricarmen FERNÁNDEZ
3   Instituto Nacional de Neurología y Neurocirugía, Departamento de Neurofisiología, México.
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A 26-year-old male with two-days prior cocaine consumption, presented with a 5-day history of new-onset focal nonmotor dyscognitive epileptic events. After three days of treatment with oral phenytoin (PHT) 100 mg t.i.d., a convulsive status epilepticus developed at the same time a third-degree atrioventricular block was registered ([Figures 1] and [2]).

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Figure 1 6 consecutive epochs (11:02:28 to 11:03:28) are shown. Montage: Bipolar, longitudinal, double-banana. HF: 70 Hz, LF: 1 Hz, NF: 60 Hz, Sens: 70 μV/cm; 13 seconds after a 10-second ventricular pause, 2–3 Hz generalized polymorphous slow waves are registered with greater expression in the anterior regions. Following this, a new ventricular pause of 9 seconds appears, which will continue in the following figure.
Zoom Image
Figure 2 The last ventricular pause described in [Fig. 1] continues for 17 more seconds (26 in total). Synchronous generalized slow waves are again registered. On the 24th second, generalized electrodecrement with muscle artifact due to a generalized tonic seizure of 4 seconds of duration. This event ends with the recovery of the heart rhythm and subsequent slow waves in delta range before recovering its alpha rhythm.

As we know, cocaine consumption and PHT (specially in infusions >50 mg/min or previous heart disease) are both related with adverse cardiovascular effects, specially arrhythmias[1],[2]. Our case exemplifies the lethal combination of both, and the narrow neurological and cardiologic assessment of syncope versus epilepsy in patients with stereotypic paroxysmal episodes[3],[4].



Publication History

Received: 21 January 2020

Accepted: 12 February 2020

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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